同种异体骨和自体骨移植在胫骨平台骨折中的应用

A comparative study of allograft versus autograft grafting in tibial plateau fracture

[目的]探讨胫骨平台骨折手术中植骨的适应证、方法及使用同种异体骨移植和自体骨移植的优缺点。[方法]通过对2000年1月～2004年8月问手术的105例胫骨平台骨折病例进行回顾性分析。手术中进行植骨的74例分为：A组（自体髂骨组）40例，男29例，女11例。年龄19—75岁，平均45．3岁。Schatzker Ⅱ型13例，Ⅲ型11例，Ⅳ型5例，V型4例，Ⅵ型5例：B组（同种异体骨组）34例，男25例，女9例。年龄21～74岁，平均43．6岁，其中Ⅱ型12例，Ⅲ型11例，Ⅳ型3例，V型4例，Ⅵ型5例；手术采用前正中、髌旁切口，用半螺纹松质骨螺钉、T型、L型或解剖型钢板支撑固定。对不同的分型分别采取相应的植骨方法。对2组患者并发症、平均手术时间，骨折愈合时间、6—12个月平台高度丢失进行比较。功能评定按Lysholm评分标准。[结果]105例手术共植骨74例，占70．5％。术后随访6个月～4a，平均21个月，A组与B组相比：A组手术时间长，平均出血量多，切口愈合时间短，骨折愈合时间无明显差异；术后平台高度丢失、膝关节功能评分均无明显差异。并发症A组主要出现在供骨区，表现在供区不适及骨疼痛7例，髂骨应力骨折1例，B组主要在受骨区，表现伤口渗液4例、延迟愈合1例，细菌培养阴性。[结论]骨移植是胫骨平台骨折治疗的重要步骤之一，掌握好它的适应证和方法对胫骨平台骨折的预后至关重要。适应证和方法主要根据Schatzker分型和结合cT检查来决定。同种异体骨移植和自体骨移植在胫骨平台骨折的治疗中各有优缺点，同种异体骨移植是安全、值得提倡的移植材料。

[ Objective] To study the indication and methods of bone grafts used in tibial plateau fracture and compare the character of allograft with autograft. [ Method] A retrospective study was done in 105 cases of hospitalized from Jan. 21300 to Aug. 2004. Seventy-four cases accepted bone graft. These 74 cases were divided into two groups. Patienets in group A accepted auto- graft （ n =40）, the patients were 19 to 75 years old,with a mean age of 45.3 years. Among them, there were Schatzker type Ⅱ in 13 cases, type Ⅲ 13 cases, type Ⅳ 5 cases, type Ⅴ 4cases, type Ⅵ 5 cases. Patients in group B accepted allograft（n =34）, the patients were 21 to 74 years old, with a mean age of 43.6 years, including Schatzker type Ⅱ in 12 cases, type Ⅲ 11 cases, type PC 3 cases, type 4 cases, type Ⅵ 4 cases, We have straight longitudinal and parapatellar incision, fixed with semiscrewed ,L-plate ,T-plate. According to the Schatzker classification, we use corresponding methods in bone graft. The two groups with operation time,complication, bone healing period, height lost were compared during the 6 - 12 months, we use Lysholm evaluation system. [ Result] Among all 105 cases, there are 74 cases accepted bone grafted. The patients were followed up 6 months to 4 years,with an average of 27.6 months. Compared with group B, group A has a short operation time, more blood loss, a shorter healing time of suture. There was no significant difference in bone healing period, height loss during the 6 - 12 months and Lysholm evaluating. Complication of group A was mainly in donor site, 11 cases have pain in donor site, 1 case has a fracture of ilium. In group B, complication were mainly in recept site, 8 cases have wound effusion, 3 cases have delayed wound healing. [ Conclusion] Bone graft is one of the most important step in treating tibial plateau fracture, mastering its application and methods is crucial to the prognosis. Allograft and autograft have their own characters, allograft is an advertising method.